New Rx Management Role for Pharmacists in Medicaid Rules

Ken Rankin

Published Online: Friday, April 1, 2005

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A final version of the new Medicare
Part D prescription drug program rules
issued by the Department of Health
and Human Services (HHS) will carve
out a key role for the nation's pharmacists
in providing counseling and other
Medication Therapy Management
(MTM) services to the nation's seniors.

A top goal of that new program,
which will begin covering a significant
part of the cost of outpatient drugs for
Medicare recipients in January 2006,
will be "to optimize therapeutic outcomes"
among elderly drug patients by
assigning pharmacists the duty of providing
MTM services.

Among other things, the final rules
envision pharmacists performing
MTM services to achieve a number of
goals, including "enhanced enrollee
understanding"of drugs, "increased
enrollee adherence to prescription
medication regimens,"and the "detection
of adverse drug events"associated
with prescription drug use.

Pharmacists will be compensated
for these services by drug insurance
plans, which may not charge patients a
separate fee for MTM benefits.

Significantly, however, HHS refused
to specifically define a minimum package
of MTM services that all Medicare
health plans must providea decision
that is likely to create uncertainty for
pharmacists and patients as the new
drug benefit takes effect early next year.

Even so, pharmacy leaders praised
the new Medicare rules as a good "first
step"toward providing prescription
benefits to the elderly.

"While not every question is
answered in these regulations,"American
Pharmacists Association Executive
Vice President John Gans, PharmD, said
that his group will continue to work
with Medicare regulators "to improve
on this foundation, particularly the role
of pharmacists in helping consumers
choose their benefit plan, and in making
the best use of their medicine through
Medicare-covered medication therapy
management services."